Background & Aims

Understanding the burden of Crohn’s disease (CD) and ulcerative colitis (UC) is important for measuring treatment value. We estimated lifetime health care costs incurred by patients with CD or UC by age at diagnosis.

Methods

We collected data from 78,620 patients with CD, 85,755 with UC, and propensity score-matched control subjects from the Truven Health MarketScan insurance claims databases (2008‒2015). Total medical (inpatient, outpatient) and pharmacy costs were captured. Cost variations over a lifetime were estimated in cost-state Markov models by age at diagnosis, adjusted to 2016 U.S. dollars and discounted at 3% per annum. We measured lifetime total and lifetime incremental cost (the difference between costs of CD or UC patients vs matched controls).

Results

For CD, the lifetime incremental cost was $707,711 among patients who received their diagnosis at 0‒11 years, and $177,614 for patients 70 years or older, averaging $416,352 for a diagnosis at any age. Lifetime total cost was $622,056, consisting of outpatient ($273,056), inpatient ($164,298), pharmacy ($163,722), and emergency room (ER) ($20,979) costs. For UC, the lifetime incremental cost was $369,955 among patients who received their diagnosis at 0‒11 years, and $132,396 for individuals 70 years or older, averaging $230,102 for a diagnosis at any age. Lifetime total cost was $405,496, consisting of outpatient ($163,670), inpatient ($123,190), pharmacy ($105,142), and ER ($13,493) costs. Therefore, the prevalent populations of patients with CD or UC in the United States in 2016 are expected to incur lifetime total costs of $498 billion and $377 billion, respectively.

Conclusions

Using a Markov model, we estimated lifetime costs for patients with CD or UC to exceed previously published estimates. Individuals who receive a diagnosis of CD or UC at an early age (younger than 11 years) incur the highest lifetime cost burden. Advancing management strategies may significantly improve patient outcomes and reduce lifetime health care spending.

中文翻译：

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按诊断年龄分列的克罗恩病和溃疡性结肠炎的终生经济负担

背景与目标

了解克罗恩病 (CD) 和溃疡性结肠炎 (UC) 的负担对于衡量治疗价值很重要。我们估计了 CD 或 UC 患者在诊断时的年龄所产生的终生医疗保健费用。

方法

我们从 Truven Health MarketScan 保险索赔数据库（2008-2015 年）中收集了 78,620 名 CD 患者、85,755 名 UC 患者和倾向评分匹配的对照受试者的数据。记录了总医疗（住院、门诊）和药房成本。在成本状态马尔可夫模型中按诊断时的年龄估计一生中的成本变化，调整为 2016 年美元，并以每年 3% 的折扣率贴现。我们测量了终生总成本和终生增量成本（CD 或 UC 患者与匹配对照的成本之间的差异）。

结果

对于 CD，0-11 岁确诊患者的终生增量成本为 707,711 美元，70 岁或 70 岁以上患者的终生增量成本为 177,614 美元，任何年龄的平均诊断成本为 416,352 美元。终生总费用为 622,056 美元，包括门诊（273,056 美元）、住院（164,298 美元）、药房（163,722 美元）和急诊室（ER）（20,979 美元）费用。对于 UC，在 0-11 岁接受诊断的患者的终生增量成本为 369,955 美元，70 岁或 70 岁以上患者的终生增量成本为 132,396 美元，任何年龄的平均诊断成本为 230,102 美元。终生总费用为 405,496 美元，包括门诊（163,670 美元）、住院（123,190 美元）、药房（105,142 美元）和急诊室（13,493 美元）费用。因此，

结论

使用马尔可夫模型，我们估计 CD 或 UC 患者的终生费用超过了先前公布的估计值。在早期（小于 11 岁）被诊断为 CD 或 UC 的个体会承担最高的终生成本负担。推进管理策略可能会显着改善患者的治疗效果并减少终生医疗保健支出。